This population-based study proposes to continue the examination of changing trends in the incidence, in-hospital, and long-term survival rates of acute myocardial infarction (AMI) and out-of hospital deaths due to coronary heart disease (CHD) in residents of the Worcester, MA, metropolitan area. The objectives of this observational study are to examine contemporary (2009 and 2011), as compared to prior (1975-2007), trends in the annual attack rates of AMI, hospital and post-discharge survival rates, management practices, and out-of-hospital deaths attributed to CHD. To accomplish these and several secondary study objectives, the proposed investigation will be carried out in the 11 acute care general hospitals providing care for residents of the Worcester, MA, metropolitan area (2000 census count=478,000). This study will utilize and extend previous approaches used in the conduct of this investigation. All new (incident) and recurrent episodes of definite AMI occurring in greater Worcester residents during 2009 and 2011 will be identified from discharge diagnostic printouts obtained from all metropolitan Worcester hospitals. The medical records of greater Worcester residents will be individually reviewed for validation purposes according to pre-established diagnostic criteria for AMI. Abstraction of the medical records of patients satisfying the diagnostic and geographic eligibility criteria will be carried out by trained physicians and nurses with the recording of demographic, clinical, and treatment related data. A review of records for additional hospitalizations and a search of death certificates will be carried out to examine the long-term survival status of discharged hospital patients from each of the proposed study years, as well as those identified previously, through 2012. Death certificates will be reviewed to identify cases of out-of-hospital deaths attributed to CHD occurring during 2009 and 2011. The results of this community-wide investigation will provide important insights from a more than 35 year (1975-2011) vantage point about the magnitude of, mortality from, and treatment approaches used in the management of the nation's leading cause of death as it affects residents of a large New England metropolitan area.